A pediatric neurosurgeon reflects on his intense job, and the post-Roe landscape
Pediatric neurosurgeon Jay Wellons regularly feels the exhilaration of saving a child from near certain death — and sometimes the anguish of failing to prevent it. He's operated on various parts of the pediatric central nervous system, including performing spine surgery on an in-utero fetus to correct spina bifida.
"Depending on the size of the fetus, [the spine] can be really small, [like] three grains of rice," Wellons says. "We use our magnifying loupes, these surgical loupes, which are magnifying glasses that we wear, and then we have a headlight on so that we can see what we're doing."
Wellons, who's from south Mississippi, says he didn't set out to become a pediatric surgeon. When he first went to medical school, he envisioned himself as a small-town family medicine doctor, who might "occasionally get paid in tomatoes and chickens." But a gross anatomy lab where he learned about the spinal cord and the nerves of the brachial plexus changed his path.
"I remember just spending hours dissecting that out and just being absolutely entranced by it. It was like macramé," Wellons says. "That was the beginning of when I realized that I may be pivoting from a great career in family medicine, which would've been very rewarding, into an entirely different career."
Wellons reflects on his experiences as a pediatric surgeon in the memoir, All That Moves Us. He says he has a big book of photos and mementos from his patients that he pulls out whenever he needs to be lifted up or grounded.
"I will always pull that file out and just flip through it and just think, 'This is why we do what we do,'" he says. "Because it's late nights. It's a lot of hours for the residents and for us in the field. But that degree of gratitude — I mean, I've experienced it as a patient. I've experienced it as a parent, and I've experienced it as a surgeon."
On how overturning of Roe v. Wade will impact patients whose fetuses have neurological defects
I will tell you a story about my niece and my niece has allowed me to talk about this. My niece ... called me one day after being pregnant for a few weeks to say, 'I'm with the OB, we've just done our 13-week ultrasound and they say that there's a problem with the brain and they say that I need to come see you, Uncle Jay.' And we get her into the fetal clinic, we do the ultrasound. I'm right there with them the whole time — my niece, who I've known since she was a baby, my children walked in her wedding — and there's this encephalocele. It's giant. And the entire brain is on the outside of the skull and it's kind of inverted. So now it's also at the mercy of amniotic fluid, which is that caustic fluid that gets more caustic over time, which is why fetal surgery for spina bifida makes a difference.
So in that scenario, the choices are to have a child that is ultimately born, that's in constant pain, that has no ability to communicate or see or interact with the world around them. They're in a wheelchair, the type of wheelchair that holds your neck still. They have G-tube feedings and over time they never grow up from being a baby. They become adults who have that degree of care that's needed. In situations like this before, with other patients, we've talked about termination and that's what we talked about with my niece. ...
We're going to see a lot more of these now and we're going to have to, as a society, understand that we're going to have to take care of these children. That's our job.
On performing in-utero surgery to correct spina bifida on a fetus
The mom comes into the operating room, she goes to sleep, lines are placed, her stomach is prepped. And then there's an entire team called MFM, the maternal fetal medicine team. ... So the belly is prepped, an incision is made, the uterus is exposed. It's like an orange-pink soccer ball. And the team will ultrasound the dome of the uterus, find a good place to open, make the incision, expose the inside of the uterus, which is where the fetus is. And so, all of a sudden, at, like, 20 to 22 weeks, we're down there looking at this little back that's rotated into place. And at that point is when we do the repair of the back to get that closed in order to reduce some of the long-term sequelae that can occur from spina bifida.
On being a parent and dealing with the death of his patients
I think you have to actively decouple when you're in the middle of it, particularly if you have children and you're a pediatric neurosurgeon. It's almost like I envision myself pressing a clutch to kind of disengage that gear. It's not that easy. ...
[I] kind of have this place that I go to that's just outside of my vision, and it's just kind of a beautiful green field that I think of. I can take kind of the memories and the experience of these [patients] and I can envision myself putting them in a box. It's not like I forget those children. It's just that it's a place that we put them. And I think that's a common feeling among surgeons that deal with things like life and death.
On the importance of communicating clearly with his patients' families
As much as you want to pull the punch, or as much as you don't want to have to be saying it, or as much as you don't think that you could take it if it was being told to you, it's still your job to make sure that they know and they understand. It doesn't mean you can't deliver that without compassion: "I'm so sorry to be having this conversation with you, but your daughter is really sick and we need to get her to the operating room right now." So to some extent, making sure they understand the situation is important, making sure that they understand what the plan is ... making sure they understand what's going on, making sure [they know] what the risks are and then telling them what we're going to do. And then being with them, not stepping away afterwards, going and talking to them after surgery and then, [making rounds] as much as you need to in the ICU, and I think that's critically important as well.
On assault weapons as a public health issue
I've seen some really horrible injuries from gunshot wounds, and it's not specific to assault weapons, but I've seen some injuries to the brain and to the spinal cord leaving a girl paralyzed, quadriplegic on a ventilator. And this has just been part and parcel of a society that has guns in them. ... Nowadays what we see with these assault weapons is that there's so much damage. I have a friend, Jon Martin, who is the chief of pediatric neurosurgery up at Connecticut Children's Hospital. And after the Newtown [Sandy Hook] shootings, he describes them all gowned up and waiting in the hospital for the children to get there until they realized that nobody was really coming because so many people had died. And I just have a hard time understanding why we need these assault weapons within society.
Sam Briger and Seth Kelley produced and edited this interview for broadcast. Bridget Bentz, Molly Seavy-Nesper and Laurel Dalrymple adapted it for the Web.
DAVE DAVIES, HOST:
This is FRESH AIR. I'm Dave Davies in today for Terry Gross. Our guest today, Jay Wellons, is used to operating on tiny brains - not just brains but all parts of kids' central nervous systems, including the spine of a fetus he described as being the size of three grains of rice stacked together. As a pediatric neurosurgeon, Wellons uses amazing advances in medicine to heal and repair children suffering from illnesses and injuries, some caused by car accidents, sports collisions and, increasingly, gunshot wounds. But in practically every case, he's also dealing with parents confronting their worst fear - the prospect of losing a child. Wellons writes that he's cried with parents from relief and sometimes from sadness and sometimes in a locker room when no one else was there.
Dr. Jay Wellons is a professor of neurological surgery at the Monroe Carell Jr. Children's Hospital at Vanderbilt and the Vanderbilt University Medical Center. He's also medical director of the Surgical Outcomes Center for Kids, which he co-founded. And he's written op-ed pieces for The New York Times. He reflects on his experiences in a new memoir titled "All That Moves Us: A Pediatric Neurosurgeon, His Young Patients, And Their Stories Of Grace And Resilience." Well, Jay Wellons, welcome to FRESH AIR.
JAY WELLONS: Thank you, Dave.
DAVIES: The book is told mostly through cases. You take a chapter and tell us a story. And I wanted to begin with one. This is a while back. You were practicing in Birmingham, Ala. You get a call from an emergency room physician in, I think, Auburn, which is about a hundred miles away.
DAVIES: He has a 9-year-old girl who was injured in an auto accident. What does he tell you?
WELLONS: Well, it's unbelievably bad weather. And, you know, most - you know, most tertiary medical centers have, you know, helicopters that fly back and forth bringing - you know, bringing people in who need to be seen, you know, urgently or emergently. And, you know, I get this call one Saturday morning directly to me from an emergency room doctor down in Auburn, in the kind of Opelika area of Alabama, and he says, you know, I've got this patient, and she's an hour and a half out from her injury, and, you know, the medevac helicopters aren't running because the weather is so bad. And, you know, Dave, you have, like, 2 1/2, 3 hours of this kind of golden window to really intervene, and so the clock is really ticking at this point.
And, you know, at the time, she was around the age of 10. She'd been in this terrible car accident, and she had a blood clot on the side of her head, and it was pushing on her brain. And she'd blown a pupil, which is the sign of - that, you know, she was close to herniating, which is where the brain swells so much that, you know, the patient ultimately dies. So this was just a full-on emergency. And at the time in Birmingham, I had a picture on my desk of my dad in his flight suit holding his helmet. He was an Air National Guard pilot. And he's standing next to the F-4 that he flies. And I look at the flight suit, and I just say, you know, to the ER doc - I'm like, look; are those Blackhawks still flying down there? Because if they are, call the Blackhawks. And he was like, oh, that's a brilliant idea. OK, bye.
DAVIES: And the idea was that those military pilots will fly in any weather (laughter).
WELLONS: In any weather. And, you know - and so, you know, I'm like, oh, my gosh, they're here. So I went down to the ER, and they were just moving her from the gurney to the trauma bay. And there were two of those medevac soldiers there in their flight gear, and they were just dripping with water, you know, because they had just done whatever it took to get that girl to us. And I remember one of the young soldiers - I walked up, and a nurse said, oh, hey, Dr. Wellons, your patient's here. And I guess maybe one of the young soldiers knew to deliver this patient to Dr. Wellons. And he, like, immediately snapped to attention, and I was like, at ease, soldier. I should be the one saluting you. You guys have just saved this girl's life.
DAVIES: So you get her to the operating table. Things were pretty critical, right? What was the situation?
WELLONS: Well, she had a large blood clot on the side of her head. It was pushing her brain to one side. It was causing her to have what's called hemiparesis, or weakness. But her pupil was blown. She was really unresponsive. Again, pupil blown means that there's a lot of pressure inside your head. And so at that point, we needed to get the blood clot out. And so, you know, I had talked to the OR. They were ready. You know, one, two, three - got her over the bed and turned her around and started clipping hair and prepping and making the incision.
And when you do these cases on an elective basis, you know, for nonemergent things, you know, you're kind of taking your time to each layer you go in. But in situations like this, you know, the clock is ticking. And so, you know, it's like, knife, drill, retractor, scissors, blood clot. You know, it's like - it's that fast 'cause you're trying to get it out. And really, once we opened up the dura, which is the leathery covering of the brain, the blood clot just kind of - blub (ph) - just kind of squirted its way out. And it was like - almost like a piece of liver, you know? It just - it would congeal and just under so much pressure. And then we could see that little vessel pumping, you know, and so we just stopped it and irrigated and closed her up. And it was a good feeling to get that done.
DAVIES: There's that moment then after, you know, you've - hopefully you've resolved the problem, but then you've got to see the patient respond. How did this little girl do?
WELLONS: Well, I remember - you know, it was early in my practice. I remember, you know, getting her back up to the pediatric ICU with our neurosurgery resident who was working with me. And, you know, I just remember sitting next to her bed. You know, she's got a head wrap on, all these lines and IVs that are in people that, you know, we're used to in neurosurgery. But I just remember seeing her parents' faces and just how this was their, you know, beautiful child. They - you know, when all the world was young, I mean, just everything was just - all the potential. And now everything is just summarized down to this one very dense spot where she was and, you know, where we were waiting to see how she would recover. And, you know, the flicker of the eyes open - that's a miraculous feeling, Dave, you know, to see somebody wake up after something like that.
DAVIES: So she was OK. Did you stay in touch with the family after that?
WELLONS: Absolutely. You know, she had some residual weakness just from how much pressure the blood clot was putting on her brain. And, you know, you follow up patients, and, you know, you see them back in a few weeks to get their stitches taken out, and then you maybe might see them in six months to get a scan. You know, you'll follow them for a finite period of time. And every time I would see her in clinic, you know, it was some milestone accomplished, some amazing thing that she'd done, you know, as she was continuing to grow and get on the honor roll or, you know, being a school mascot or, you know, winning a competition. And then it was time to discharge her from clinic because, you know, other than just me wanting to physically see them and see how well she was doing, it really - she didn't need me anymore. And the family continued to send clippings and send updates and send messages, you know, until I got an invitation to her wedding, which was kind of amazing, as you can imagine, you know?
DAVIES: Well, you know, this is the thing. I mean, I - as a parent, I can only imagine what it would be like to bring your child in, you know, on the door of death and have this miraculous operation, and then they are restored, and they proceed with their lives. I would imagine that's something that you would never forget. Do you have a big book of photos and mementos from patients you've treated?
WELLONS: (Laughter) Yeah, I have a big file in a big drawer. And, you know, whenever I need to be lifted up or grounded, you know - or one of the two - I guess I will always pull that file out and just flip through it and just think, you know, this is why we do what we do because, you know, it's late nights. It's a lot of hours for the residents and for us in the field. But that degree of gratitude, I mean, I've experienced it as a patient. I've experienced it as a parent. And I've experienced it as a surgeon. And so as I've gotten 20 years into this job and in this career, you know, when somebody tells me thank you for, you know, a particular clinical course that has done well, you know, or a miracle that's been answered or however you want to say it, you know, I really understand that. I really try to let that wash over me in the way that it deserves, you know, that gratitude for - you know, for their child being OK or their child making it through or helping them navigate a tough situation where their child did not live, which is an incredibly difficult thing, too.
DAVIES: We're going to take a break here. Let me reintroduce you. We're speaking with Dr. Jay Wellons. He is a pediatric neurosurgeon at Vanderbilt University Medical Center. His new memoir is All That Moves US. We'll continue our conversation in just a moment. This is FRESH AIR.
(SOUNDBITE OF TODD SICKAFOOSE'S "TINY RESISTORS")
DAVIES: This is FRESH AIR. And we're speaking with Dr. Jay Wellons. He's a pediatric neurosurgeon at Vanderbilt University Medical Center. He has a memoir about his experiences. It's titled "All That Moves Us: A Pediatric Neurosurgeon, His Young Patients, And Their Stories Of Grace And Resilience."
I'd say most of the stories that you relate in the book are of successful outcomes, but not all. And you write about a girl early in the book called Delayla (ph), I believe. She was 8 when you first encountered her. And she had a glioblastoma, which is a very, I guess, highly aggressive brain tumor. You cared for her for how long, over how many operations?
WELLONS: I mean, it was over the course of her year and a half, two years that it took for the - for her to finally, you know, succumb to a GBM. I mean, it's a Grade 4 malignant glioma. And it's very challenging, and it's been - to treat. And it's been very challenging for many, many years from - you know, from the moment I began my neurosurgery career to - it's just been a tumor type that has eluded, you know, the investigators to try to figure out what to do next after it's resected. So what's the best chemotherapy? What's the best radiation therapy? It's just a really challenging tumor to have. And - yeah, and that's what Delayla had.
DAVIES: And you got to know her and her mom, Leslie (ph), over a lot of visits. What was their relationship like?
WELLONS: Yeah. Well, Leslie was amazing woman. So I met Delayla, really, when she came in after being blind, you know? For a short period of time, her mom just realized that she had gotten closer and closer to the TV and that she just couldn't see. She bumped into a wall. And, you know, basically, we decided to take her to the OR, you know, that afternoon to - when she arrived to take out this, you know, very large brain tumor.
And once we were finished and we took it out and, you know, we saw her wake up - and I held a pen in front of her, and she named pen. And I held, you know, my phone or my thumb. And she named each thing. I was able to go out and tell Leslie, like, you know, she could see now. And I held out the pen that I'd, you know, held in front of Delayla. And I remember Leslie reaching out and touching that pen just to, like, have some kind of tactile feeling that - to know that she had seen that. So definitely, over the years and over the time of caring for somebody, you develop a relationship. You bet.
DAVIES: You've titled this chapter "Stitches." You want to explain why?
WELLONS: (Laughter) Yeah. So you know, when you close a wound, you can use suture. You can use staples. You can use the type of suture that absorbs over time. I use the standard, good old-fashioned stitches that need to be clipped out because that's just - to me, it is the best for wound healing. And so at the end of the day, those stitches need to get clipped out in two or three weeks. And I just - over the years, I just haven't been the person to take the stitches out, you know? The kids are scared of it. They think it's going to hurt. And we have a wonderful assistant that does this for us in the clinics and does it in a caring and loving way. But - so that's kind of the background of "Stitches."
And then at the end, when Delayla is close to death and I realize that I've had the last conversation with her and with Leslie, I remember walking away because she had had another surgery to try to help alleviate some symptoms, I realized that I was going to take those stitches out. There was - nobody else was going to do it. It was mine to do. I wanted to do it. And so I just remember going into her hospital room and just, you know, having her turn away and just very carefully clipping those stitches out, like, using the same amount of skills that build up over 20 years of being a micro-neurosurgeon, and just sweet Leslie just being there, holding her hand, sometimes turning her head to cry. But that was a very important thing for me to do, Dave.
DAVIES: And it was the last time you saw her.
WELLONS: It was. Yeah. Yeah.
DAVIES: It's hard to hear about this. It's hard to imagine the stress and pain that comes with getting to know a kid and having the parents hope against hope that you're going to be able to beat this. And sometimes, you can't. Do you have techniques for dealing with this kind of pain and stress?
WELLONS: Yes. I - you know, I think you have to actively decouple when you're in the middle of it, particularly if you have children and, you know, you're a pediatric neurosurgeon. It's almost like I can envision myself, you know, pressing a clutch in just to kind of disengage that gear. It's not that easy.
DAVIES: I mean, that gear that connects you with your own kids? I mean, you don't...
WELLONS: Yeah, that's right.
DAVIES: You don't want to think about that this could be you?
WELLONS: That's exactly right. You know, otherwise - and it certainly happens to me, you know? Car seats are as important as, you know, Gunter from the Apollo missions, you know, strapping the kids in like, Daddy, I can't breathe, you know? I mean, like, those become - things like that and bike helmets and, you know, having your child get on a bike and ride away, you know? There's - so many stories can come back to you. So you have to do your best to try to disengage the parent part from the neurosurgeon part, if you can. It's easier said than done. But at the end, when some of these stories like Delayla and like others who've not made it are - they're very sad.
I do kind of have this place that I go to that's just outside of my vision. And it's just kind of a beautiful, green field that I think of. And, you know, I can take kind of the memories and the experience of these children and just - I just can envision myself putting them in a box. It's not like I forget those children. It's just that it's a place that we put them. And I think that's a common feeling among surgeons that deal with things like life and death.
DAVIES: You've had to talk to parents so many times under these excruciating situations, again and again. And you must have learned over the years some things to remember. Have you learned things that you need to do or avoid doing when you talk to parents in these situations?
WELLONS: Oh, definitely, yeah. You know, I think, there are this child's parents, and it is your job to make sure that they understand exactly what is going on. That's one thing that I think is very important. As much as, you know, you want to pull the punch or as much as you don't want to have to be saying it or as much as you don't think that you could take it if it was being told to you, it's still your job to make sure that they know and they understand. It doesn't mean you can't deliver that without compassion, you know? You know, I'm so sorry that - to be having this conversation with you, but your daughter is really sick, and we need to get her to the operating room right now.
You know, so to some extent, making sure they understand the situation is important, making sure that they understand what the plan is, because my good friend and chairman here at Vanderbilt, Reid Thompson, talks about there being peace with a plan. And it doesn't matter if that plan is sitting in a clinic talking about what the surgery is going to be, or it doesn't matter if that is in the middle of the emergency room, trying to tell somebody that you need to get their child to the operating room as fast as possible. Once you know that there is a plan, you know, then there's a degree of peace to say we are now moving towards resolution. I think that's critically important.
DAVIES: You need to tell them not only how serious the situation is, but also the risks in trying to resolve it, right? And sometimes there are tough decisions to make there, right?
WELLONS: Yeah. No, that's right. And, you know, getting consent for surgery is a - is the official term for saying, you know, talking to families or patients so that they understand what the risks of surgery are. And for some of these things, like life-threatening blood clots, you know, depending on where they are in the brain, there is some risk that the patient may not make it through surgery. And so, you know, thankfully, that's low now with the teams that we have and the preparation that's done. But at the end of the day, it is important for parents to understand that, too.
And so I think, you know, putting it all together, it's making sure they understand what's going on, making sure what the risks are, you know, and then telling them what we're going to do. And then being with them, you know, not stepping away, you know, afterwards - you know, going and talking to them after surgery and then, you know, rounding as much as you need to in the ICU. And I think that's critically important, as well.
DAVIES: When a parent is distraught and weeping, do you comfort them physically? I mean, with a, you know, a hand on the shoulder or a hug? Do you have any guidelines about that?
WELLONS: Well, I mean, you know, there is this aequanimitas, you know, where - there's this kind of dispassionate place that you can go to. Over the years, you know, having been a patient and having children now, I think when I see somebody really having to manage a great deal of grief, you know, I'm comfortable putting a hand on their shoulder and just saying, I'm so sorry this is happening. And then I'll let them take it from there. If a hug is what is needed, then I will give them a hug. You know, if they want me to stand with them in a prayer circle, I will certainly stand with them in a prayer circle. And it doesn't matter which religion of prayer circle that it is, because that is an extremely important part of people's lives. And so I think there are ethical lines drawn, but at the end of the day, I don't think there's anything wrong with, when somebody is handling grief about their child, to show some compassion and be real about it.
DAVIES: Right. And then sometimes your words don't matter. You describe one situation in which you literally fled, fearing physical violence from some angry parents, right?
WELLONS: Yeah, that was a tough one. That was in my training. And it had to do with a patient who basically coded on the table. It was an adult patient. And we were able to bring her back, get her up to the ICU, get her stabilized, and then make plans to do the neurosurgery again because it was a heart issue that she'd had. And the night before we were going to do the carotid endarterectomy, where we clean out the carotid to help prevent a stroke, she basically had an arrhythmia and died.
And, you know, this is back in the days before cellphones. And we tried to call the family, and we tried to let them know. And I was walking down this long hall after 10 p.m. at night, and the family kind of surrounded me. And there was a lot of anger and a lot of blaming. And it's an incredibly sad time that brings out the worst and the best in people. But at that moment, I realized that I was extremely vulnerable and, you know, that my white coat did not protect me from, you know, the emotions that come around death and dying that some people have.
DAVIES: Yeah. You said you actually ran full speed away from them.
WELLONS: I did, full speed. I mean, I can still see it in my head. I can still see that long hall, the lights, you know, (imitates buzzing) the lights kind of flickering on and off. There's an exit sign at the end, and there's a door. And I'm like, if I can just make it to that door, I can close that door and they won't be able to - it'll give me enough time to get in my car and - you know, it was just - it was a remarkable experience.
DAVIES: Let's take a break here, and let me reintroduce you. We are speaking with Dr. Jay Wellons. He is a pediatric neurosurgeon at Vanderbilt University Medical Center. His new memoir is "All That Moves Us." We'll be back to talk more after this short break. I'm Dave Davies, and this is FRESH AIR.
(SOUNDBITE OF BILL FRISELL'S "KEEP YOUR EYES OPEN")
DAVIES: This is FRESH AIR. We're speaking with Dr. Jay Wellons. He's a pediatric neurosurgeon at Vanderbilt University Medical Center and medical director of the Surgical Outcomes Center for Kids, which he co-founded. He has a new memoir reflecting on his experiences operating on children facing critical illnesses and injuries and helping their parents cope with the wrenching, emotional challenges of having a child in mortal danger. The book is "All That Moves Us: A Pediatric Neurosurgeon, His Young Patients, And Their Stories Of Grace And Resilience."
You know, we're used to modern medicine having these miraculous techniques, but I got to say - I mean, the description of your operation on a fetus in the womb was - is pretty mind-boggling. This is a surgery to correct a condition that leads to spina bifida. You want to explain what the condition is that you have to correct in this circumstance?
WELLONS: Yep, absolutely. So spina bifida is a condition where the spinal cord basically does not form normally. And in the first few days after conception as the - you know, as the cells begin to flatten out into this neural plate - that's what it's called. It then rolls up into a tube, and then our body is formed around this neural tube. Well, if that neural tube at around the 21st or 24th day doesn't form all the way and round itself up into this tube, then everything is formed around it, but the nerves don't work. The spinal cord is exposed to the outside. And there are other things that can happen from that. Not only does the child have risk - you know, loss of bowel and bladder function and difficult with walking and moving the legs - but something called hydrocephalus, which is part and parcel for what pediatric neurosurgeons deal with - something called hydrocephalus forms, and that's where the spinal fluid - it's actually made in the brain - gets backed up.
And so for many, many years, this was repaired what's called postnatally, which is, you know, in this 48 to 72 hours after the baby was delivered. And, you know, it's an operation where the - you know, you've got a 38, you know, week baby or a 39-week baby, and, you know, you've got a sizable child, and you, you know, do your repair. You dissect out the thing you need to dissect, the neural placode, and you roll up the dura, and you do all the procedure that you're supposed to do. Well, somebody had the big idea that - what if we could correct this in utero as a fetus? Like, A, can we do it? And, B, does it make an impact? And that somebody was a guy named Noel Tulipan who worked at Vanderbilt, and he retired a few years ago and, ultimately, passed away. But before he did, he passed on kind of this legacy of fetal surgery. And it's remarkable to be a part of this team.
DAVIES: You know, so this is a surgery that you've undertaken. In fact, in the book you describe doing it in Australia with some surgeons there for the first time on that continent. So what's fascinating is that you're in the operating room, and you're going to do the operation on the fetus, but there's another surgical team that has to help you get there, right? I mean, this is a...
WELLONS: Yeah, that's right.
DAVIES: ...Pretty complicated thing. Kind of just in basic terms, what happens when you do this?
WELLONS: Well, the - you know, the parents are counseled. You know, they're - it's determined if we think, as a team, that there would be a benefit to surgery, right? And so the mom comes into the operating room. She goes to sleep. Lines are placed. Her stomach is prepped. And then there's an entire team called MFM, the maternal fetal medicine team. And this happens across all the different institutions around North America - and now the world - that are doing fetal surgery that have kind of rolled out, you know, after this particular study came out that was so, so positive.
So the belly is prepped. An incision is made. The uterus is exposed. It's like a - you know, like an orange, pink, you know, soccer ball. And the team will ultrasound the - you know, the dome of the uterus, find a good place to open, make the incision, expose the inside of the uterus, which is where the fetus is. And so all of a sudden at, like, 20 to 22 weeks, you know, we're down there looking at this little back that's rotated into place. And the - and from that - at that point is when we do the repair of the back to get that closed, in order to reduce some of the long-term sequela that can occur from spina bifida.
DAVIES: Right. This is where you describe finding this spine, which you describe as, basically, the size of three grains of rice end to end?
WELLONS: Yeah. Yeah. It is - you know, it can be - depending on the size of the fetus, it can be really small, three grains of rice. It can be a little bit bigger. But most of the time, it's quite small. And, you know, we use our magnifying - they're called loops, these surgical loops, which are magnifying glasses that sit - you know, that we wear. And then we have a headlight on so that we can kind of see what we're doing. I'll also tell you that as I've gotten past 50, I had to get a new pair of loops that would magnify it a little bit more for me so that I could see because it's so small, you know?
DAVIES: You describe one of these surgeries where it went in a critically dangerous direction. The fetus was in a challenging position. You had to manipulate it a bit. What happened?
WELLONS: Well, you know, there I am, you know? The whole operating room has done their part, and, you know, in comes the pediatric neurosurgeon, and in comes my assistant, a terrific resident at the time named Becca Reynolds, who ultimately is now training - doing a fellowship year in pediatric neurosurgery. So, you know, we're beginning the process of trying to rotate the back up so that we can have access to it. And it's hard, and it keeps falling in a different direction, but we're able to get it up to where we need it to be.
And then we start to close the - you know, to dissect that abnormal neural tissue, the three grains of rice, away from the skin so that we can, you know, begin to make the closure. And all of a sudden, Dave, there was just a wash of blood over my knuckles, like a tsunami. And it was in my loops, so it was giant, you know? It was like - it was - it looked like it was the whole room. And Kelly Bennett, who's the head of our team, I remember - I mean, her saying, like, we've got an abruption; we need to deliver the baby. And at this point, I'm holding on, you know, to the fetus. And she's like, Jay, you have to let go. Like, we have to deliver the baby. And so I remember just stepping back and watching as all the remainder of my team members, like, just went into the breach, you know? All of a sudden, the flash of steel, you know?
DAVIES: That's what - when the placenta has detached, that's what had happened?
WELLONS: Yeah, basically, what happened is the placenta had begun to pull away from the uterine wall and then - which causes a massive amount of bleeding. And placental abruption is considered an emergency for our OB-GYN colleagues, and it's an emergency when you're definitely in the operating room trying to do an operation on a fetus. Yeah, that's exactly what had happened. Placental abruption, it's called.
DAVIES: So you said you became a bystander here, right?
WELLONS: I did. I did. It took me five minutes to realize that I was still standing there holding my microinstruments in the air as all these things were happening. Like, three battles raged around me, you know? The anesthesia is just pumping in blood to keep this young mother alive. And then the maternal fetal medicine team is squeezing down on the uterus, putting these big, heavy stitches in to try to save her uterus. And then behind me, this limp, little 21-week organ, almost, you know, was thrust into the hands of the neonatology team that's there, and they're putting in tiny, little tubes, and they're breathing little bits of air and putting medicine down the tube. And, you know, there's just three battles raging around me. And I literally, like you said, am a bystander.
DAVIES: And in this case, they managed to stabilize the mom. She recovered. And the fetus survived, right? And then - do I have this right? - two days later, when the fetus is stabilized, then you went in and did the surgery?
WELLONS: Well, actually, Dave, we did it right there. You know, the...
WELLONS: What happened is that the, you know, anesthesia was like, I think we got control, guys. And I saw that the MFM team had decided that, hey, we're going to be able to keep the uterus. And so - and then I looked behind me, and the neonatology team was calm. Somebody even, like, cracked a joke, you know? And I was just amazed, you know, at the - at what it takes. You know, you practice for this over and over again. You know, airline pilots practice for this. Surgeons practice for this. Lots of people practice for chaos and for things to go south. But, you know, to go from like, I don't know, the camera's on you to all of a sudden being a bystander and watching the people that you worked with for 10 years, like, step into the breach and fix the situation was pretty amazing.
So it was a scrub nurse, Melissa (ph), who was with us. And when we did that Australia trip a few years ago, she saw me look at the baby, and she said, hey, Dr. Jay, I've still got your instruments sterile. I've kept them sterile on the back table. And I went over and asked the neonatology team - I said, hey, you know, what if I closed the back? Could I do that while we're here? And they were like, can you do it in 20 minutes? I was like, you bet. And so that's what we did. So we got it closed right there in the operating room, you know?
DAVIES: Is that a healthy person today, that fetus?
WELLONS: Yeah. Ramsay's (ph) amazing.
DAVIES: Wow. Wow.
WELLONS: Yeah, she is. And her parents are just - they're just the most amazing people. They were just grateful the whole time. It's just been a series of just shared gratitude between our teams and the families and getting pictures of Ramsay. You know, it's just terrific, Dave.
DAVIES: Let me reintroduce you. We're going to take another break here. We are speaking with Dr. Jay Wellons. He is a pediatric neurosurgeon at Vanderbilt University Medical Center. His new memoir is "All That Moves Us." We'll continue our conversation after this short break. This is FRESH AIR.
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DAVIES: This is FRESH AIR, and we're speaking with Dr. Jay Wellons. He is a pediatric neurosurgeon at Vanderbilt University Medical Center. He has a new memoir called "All That Moves Us: A Pediatric Neurosurgeon, His Young Patients, And Their Stories Of Grace And Resilience."
You recently published a piece in Time magazine, an op-ed piece, about treating children with wounds from gunfire. You note that you and other neurosurgeons that you know - essentially, say if politicians could see what we see in the operating room, you might look at this issue a little differently. Over the years, have you seen more gunshot victims and different kinds of injuries?
WELLONS: You know, I've seen, you know, some really horrible injuries from gunshot wounds, and it's not specific to assault weapons. But I've seen some injuries to the brain and - or to the spinal cord, leaving, you know, a girl paralyzed, quadriplegic, on a ventilator. And this has just been part and parcel of a society that has guns in them. And I grew up as a son of the South. You know, I talk about in the piece about how I'd recently found my old childhood .22 rifle that I used to take with my dad squirrel hunting. And I taught my kids how to shoot. I taught them how to clean it and made sure they understood about how to be safe around it.
But, you know, at the same time, on the top of that old gun cabinet was a bunch of trophies from my childhood that my, you know, wonderful parents had kept, and one was the Little League team that I'd played for as a young boy. You know, 14 players on that team, and the baseball that was sitting on the trophy was signed by all of us. Two of those 14 kids died from gun violence before the age of 18. So, you know, that was 40-plus years ago.
So nowadays what we see with these assault weapons is that there's so much damage. You know, I have a friend, John Martin, who is the chief of pediatric neurosurgery up at Connecticut Children's Hospital, and after the Newtown shootings, he describes them all gowned up and waiting in the hospital for the children to get there until they realized that nobody was really coming because so many people had died. And I just have a hard time understanding why we need these assault weapons within society. You know, they're designed to - to me, it's three things, you know? They're high capacity. They're maximal velocity. And they're low recoil. And the low recoil means that you can stay on target and just pump a bunch of shots into the same place. And, you know, that's a lot of destruction, and that's a lot of destruction on a child, and a child's not going to survive that.
And the relationship that medicine and war, over the years, where we have learned things from each war, we have able to bring that back to society and say, hey, we know now how to dress a wound, or we know now the role of antibiotics or the role of steroids or resuscitation. But when these things happen and so many kids die at the scene, there's nothing that we're learning. There's nothing to bring back to society because we don't have the ability to say, OK, well, we've now learned X, Y or Z. It just doesn't happen because of the destructive force.
DAVIES: Another issue in the news, which has medical implications, of course, is the Supreme Court's overturning the Roe v. Wade ruling. Do you anticipate that that will affect your job at all?
WELLONS: Man, I got to tell you. Like, I was just - three weeks ago, I was up giving the Mike Scott Lecture at Boston Children's Hospital in Harvard. And the very first question that came at the end of my 50-minute talk was, what do you think is going to happen if the Supreme Court overturns Roe v. Wade in terms of termination for significant neural - you know, neurologic deficits that are defects? And so it is on people's minds, for sure. And I will tell you a story about my niece. And my niece has allowed me to talk about this and of - in the process of writing a piece about it.
My niece's name is Chapel (ph). And Chapel called me one day when after being pregnant for a few weeks to say, I'm with the OB. We've just done our 13-week ultrasound. And they say that there's a problem with the brain. And they say that I need to come see you, Uncle Jay. And, well, we get her into the fetal clinic. We do the ultrasound. I'm right there with them the whole time. This - you know, my niece, who I've known since she was a baby, my children walked in her wedding - and there's this encephalocele. It's giant. And the entire brain is on the outside of the skull, and it's kind of everted. So now, it's also at the mercy of the amniotic fluid, which is that caustic fluid that gets more caustic over time, which is why fetal surgery for spina bifida makes a difference.
So, you know, in that scenario, the choices are to have a child that is ultimately born that's in constant pain, that has no ability to communicate or see or interact with the world around them. They're in a wheelchair, the type of wheelchair that holds your neck still. They have G-tube feedings. And over time, they never grow up from being a baby. They are - they become adults who have that degree of care that's needed. And in situations like this before, with other patients, we've talked about termination, and that's what we talked about with my niece.
And you know, fast forward the story two years - in the hospital during pandemic with a healthy baby that they've had and a second baby that they've had. And it's just a tremendously different path. And I just - I can't tell you how much I think that this ruling is going to affect what it's like for families to have these substantial - neurologic, cardiac, urologic - encephaloceles where the gut's outside the body that is hard to be fixed sometimes. Like, we're going to see a lot more of these now, and we're going to have to, as a society, understand that we're going to have to take care of these children. That's our job. So, yes, I think it's going to have an impact.
DAVIES: Well, Dr. Jay Wellons, thank you so much for speaking with us.
WELLONS: Thank you, Dave. It's been a really tremendous honor for me to be here with you today and be on FRESH AIR.
DAVIES: Dr. Jay Wellons is a professor of neurological surgery at the Monroe Carell Jr. Children's Hospital at Vanderbilt and the Vanderbilt University Medical Center. He's also medical director of the Surgical Outcomes Center for Kids, which he co-founded. His new memoir is "All That Moves Us: A Pediatric Neurosurgeon, His Patients, And Their Stories Of Grace And Resilience."
Coming up, Ken Tucker reviews the new album from singer-songwriter Bartees Strange. This is FRESH AIR.
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